Comparison of Seromuscular Tunnel and Split-cuff Nipple Antireflux Ureteroenteral Anastomosis Techniques in Orthotopic Taenia Myectomy Sigmoid Neobladder: A Prospective, Randomized Study

Objective

To compare the functional results and complications of seromuscular tunnel and split-cuff nipple antireflux ureteroenteral implantation techniques in orthotopic taenia myectomy sigmoid neobladder.

Materials and Methods

A randomized prospective study was conducted from January 2004 to January 2009. A total of 62 patients (53 men and 9 women; all of Han ethnicity) with muscle-invasive urothelial carcinoma of the bladder and a normal upper urinary tract were enrolled in the present study. After pelvic lymphadenectomy and radical cystectomy, the ureters were randomized to implantation using seromuscular tunnel anastomosis or a split-cuff nipple technique. Regular follow-up visits included renogram intravenous urography and serum creatinine to evaluate renal function.

Results

The mean follow-up period was 52.0 ± 19.2 months (range 12-84). The serum creatinine levels remained normal in all patients throughout the study period. Stenosis occurred in 4 of 118 renoureteral units (4 patients), 2 with a seromuscular tunnel anastomosis and 2 with split-cuff nipple reimplantation. Only 1 stricture required treatment; the patient underwent retrograde balloon dilation after double-J stent insertion. The others received active surveillance, and the hydronephrosis did not worsen. No reflux was observed in any patient. One patient presented with bilateral hydronephrosis due to neovesicourethral stricture, which was treated successfully with transurethral urethrotomy.

Conclusion

No difference in stricture formation was seen between the patients treated with the seromuscular tunnel or split-cuff nipple ureteroenteral anastomosis techniques in the orthotopic taenia myectomy sigmoid neobladder. No patients developed reflux. Our results suggest that both the seromuscular tunnel and the split-cuff nipple approach are reliable antireflux ureterointestinal anastomosis techniques, with low morbidity for orthotopic taenia myectomy sigmoid neobladder.